Justin D. Provo, MD Valid NPI
Individual provider · Physical Medicine & Rehabilitation Physician · Salt Lake City, UT
- NPI
- 1720548670
- Type
- Individual (Type 1)
- Primary specialty
- Physical Medicine & Rehabilitation Physician (Physical Medicine & Rehabilitation)
- Specialty group
- Allopathic & Osteopathic Physicians
- Taxonomy code
- 208100000X
- License number
- 12017642-1205 (UT)
- Sex
- Male
- Sole proprietor
- No
- Enumerated
- 2019-03-25
- Last updated
- 2020-11-05
Practice location
30 N 1900 E Rm 1c301
Salt Lake City, UT 84132-0002
(801) 585-2589